professor, School of Business, Slippery Rock University, Slippery Rock, Pennsylvania.
J Healthc Manag. 2018 Jul-Aug;63(4):e60-e74. doi: 10.1097/JHM-D-16-00039.
This study examines how health status and experiences with cost sharing affect consumers' choices between managed care and consumer-directed health plan (CDHP) options. Human resources and claims system information were obtained from a single, large multistate employer through a third-party firm that extracted, merged, and deidentified the data for a final sample of 9,616 insured households. Multinomial logistic regression was used to estimate plan choice between a managed care preferred provider organization and two forms of CDHP. Andersen's Behavioral Model guided the cross-sectional, nonexperimental ex post facto design.Results indicate that cost sharing and health status have minimal effect on CDHP choice when operationalized as a continuous measure. However, a nonlinear association is suggested when examining the lowest and lower cost-sharing and health status groups. Enrollees in the lowest cost-sharing and best health status groups are most likely to choose a CDHP option offering a health savings account, while those in the lower cost-sharing and better health status groups are most likely to opt for a CDHP that includes a health reimbursement arrangement.This study supports the assessment that CDHPs benefit from favorable selection. Results also suggest that previously experienced cost sharing is a greater factor than health status when choosing a CDHP, particularly for those who are less healthy and who have experienced greater out-of-pocket spending. Employers should consider enrollees' experiences with healthcare plans, as these may influence plan choice and suggest features most important to employees, which can also influence healthcare-related behaviors.
这项研究考察了健康状况和成本分担经历如何影响消费者在管理式医疗和消费者导向型健康计划（CDHP）之间的选择。通过第三方公司从一家大型多州雇主的人力资源和索赔系统信息中提取、合并和去识别数据，最终样本为 9616 户参保家庭。使用多项逻辑回归来估计管理式医疗优先供应商组织和两种形式的 CDHP 之间的计划选择。安德森行为模型指导了横截面、非实验性事后设计。结果表明，当以连续衡量时，成本分担和健康状况对 CDHP 选择的影响很小。然而，当检查最低和较低成本分担和健康状况组时，建议存在非线性关联。成本分担最低和健康状况最佳的参保人最有可能选择提供健康储蓄账户的 CDHP 选项，而成本分担较低和健康状况较好的参保人最有可能选择包括健康报销安排的 CDHP。这项研究支持了对 CDHPs 受益于有利选择的评估。结果还表明，在选择 CDHP 时，以前经历的成本分担比健康状况更为重要，特别是对于那些健康状况较差且自付费用较高的人。雇主应考虑参保人的医疗保健计划经验，因为这些经验可能会影响计划选择，并表明对员工最重要的特征，这也会影响与医疗保健相关的行为。
